后路椎体切除减压椎间植骨融合椎弓根螺钉内固定术治疗严重胸腰椎旋转骨折脱位

Management of severe rotational throracolumar fracture and dislocation with posterior decompression by vertebral body resection, interbody bone fusion and transpedicular screw internal fixation

目的探讨后路椎体切除减压椎间植骨融合椎弓根螺钉内固定术治疗严重胸腰椎旋转骨折脱位的可行性及疗效。方法2007年10月-2008年7月采用后正中切口、后路经椎弓根行椎体切除减压、椎体间植骨、长节段椎弓根螺钉内固定治疗严重胸腰椎旋转骨折脱位（AO分类C型损伤）患者9例，其中男8例，女1例；年龄23～54岁。全部患者伤椎累及T11～L2。AO分类：C1型压缩骨折伴旋转侧方移位3例，C2型牵张性损伤伴旋转脱位5例，C3型旋转剪切骨折脱位1例。神经功能Frankel分级：A级3例，B级1例，C级4例，D级1例。术后随访骨折脱位复位、植骨愈合和神经功能恢复情况。结果9例患者全部完成手术，手术时间3．5—5．8h，平均4．4h。术中出血1200—3500ml，平均1800ml。术后X线片示骨折脱位完全复位，植骨位置良好：3例Frankel A级无恢复，1例B级患者恢复到C级，4例C级患者有3例恢复到D级。随访9例患者植骨面见骨性愈合，未发生内固定或植骨材料松动、移位或断裂。结论胸腰椎旋转骨折脱位对减压、复位、融合和固定的要求很高，后路椎体切除减压椎间植骨融合椎弓根螺钉内固定术能从单一入路同时完成上述治疗。

Objective To explore feasibility and therapeutic effect of posterior decompression by vertebral body resection, interbody bone fusion and transpedicular screw internal fixation in treatment of severe rotational throracolumar fracture and dislocation. Methods From October 2007 to July 2008, nine patients with severe rotational throracolumar fracture and dislocation classified as AO C types underwent decompression by vertebral body resection, intervertebral bone fusion and transpedicular screw internal fixation via a posterior midline small incision. There were eight males and one female, at age range from 23 to 54 years. All patients involved levels at T11-L2. According to AO classification, there were three patients with type C1 bursting fractures with rotational dislocation, five with distraction fracture combined with rotational dislocation and one with rotational distraction shear fracture/dislocation. The preoperative Frankel Grading was Grade A in three patients, Grade B in one, Grade C in four and Grade D in one. Postoperative neurological status, the correction and loss of dislocation and the location and union of bone graft were reviewed. Results All patients received successful operation, with operation time of 3.5-5.8 hours （ mean 4.4 hours）, blood loss of 1 200-3 500 ml （ mean 1 800 ml）. The followup period in nine patients was 3-12 months （mean seven months）. Postoperative X-ray photographs showed that the dislocation in all patients was reduced, the spine curvature was recovered to normal and the intervertebral bone graft was well fixed. Three patients at Frankel Grade A had no improvement, one at Grade B was improved to Grade C. Of four patients at Grade C, three patients were improved to Grade D. The followup showed bony fusion in all patients, with no loosening, dislocation or breakage of the internal fixation or implants. Conclusions For severe rotational throracolumar fracture and dislocation, decompression, reduction, fusion and fixation are rather difficult, while sufficient posterior decompression by vertebral body resection, rigid interbody bone fusion and transpedicular screw internal fixation can be an effective altecnative measure.